ASSOCIATION OF ORTHOSTATIC HYPOTENSION WITH ABNORMAL BLOOD PRESSURE PHENOTYPES

초록

Objective: Orthostatic hypotension (OH) is recognized as a poor prognostic factor, but its blood pressure (BP) phenotypes remain poorly understood. This study aimed to investigate the BP phenotypes associated with OH. Design and method: This study included 306 patients who underwent a head-up tilt test (HUT) and ambulatory blood pressure monitoring (ABPM) for typical OH symptoms. OH was defined as a decrease in systolic BP of at least 20mmHg in normotensive individuals or at least 30mmHg in patients with supine hypertension within 3 minutes of HUT. BP phenotypes were categorized as follows: normal BP patterns vs. abnormal BP patterns [white coat hypertension (WCH: elevated office BP with normal ambulatory BP during awake hours), masked hypertension (MH: elevated ABPM but not office BP), and sustained hypertension (elevated office BP and ABPM)]. Dipping patterns were classified as dipper, nondipper, reverse dipper, and extreme dipper. Results: The study population consisted of 306 patients, including 202 (66%) in the OH-positive group and 104 (34%) in the OH-negative group. The proportion of females was 70.3% (n=176), and the mean age was significantly higher in the OH-positive group compared to the OH-negative group (57 ± 17.9 vs. 48 ± 17.0years). The proportion of patients receiving antihypertensive medication was also significantly higher in the OH-positive group (66% vs. 34%, p=0.001). The OH group showed a higher prevalence of abnormal BP patterns including WCH, MH, sustained hypertension, [(WCH (7.7% vs 8.9%), MH (9.6% vs 18.3%), sustained hypertension (2.9% vs 7.4%) in OH negative vs OH positive group], respectively, p=0.047], but no significant differences were observed in dipping patterns (p=0.233). Conclusions: Orthostatic hypotension is associated with abnormal BP patterns which might lead to poor prognosis, emphasizing the importance of evaluating BP phenotypes in these patients.